Brain injury; Head trauma; Concussion
A head injury is any trauma that leads to injury of the scalp, skull, or brain. The injuries can range from a minor bump on the skull to serious brain injury.
Head injury is classified as either closed or open (penetrating).
A closed head injury means you received a hard blow to the head from striking an object, but the object did not break the skull.
An open, or penetrating, head injury means you were hit with an object that broke the skull and entered the brain. This usually happens when you move at high speed, such as going through the windshield during a car accident. It can also happen from a gunshot to the head.
*Head injuries include:
Concussion, the most common type of traumatic brain injury, in which the brain is shaken
Contusion, which is a bruise on the brain
Sx of Head Injury
The symptoms of a head injury can occur immediately or develop slowly over several hours or days. Even if the skull is not fractured, the brain can bang against the inside of the skull and be bruised. The head may look fine, but complications could result from bleeding or swelling inside the skull.
In any serious head trauma, always assume the spinal cord is also injured.
Some head injuries result in prolonged or nonreversible brain damage. This can occur as a result of bleeding inside the brain or forces that damage the brain directly. More serious head injuries may cause the following symptoms:
Changes in, or unequal size of pupils
Chronic or severe headaches
Fluid draining from nose, mouth, or ears (may be clear or bloody)
Fracture in the skull or face, bruising of the face, swelling at the site of the injury, or scalp wound
Irritability (especially in children)
Loss of consciousness, confusion, or drowsiness
Loss of or change in sensation, hearing, vision, taste, or smell
Low breathing rate or drop in blood pressure
Mood, personality, or behavioral changes
Restlessness, clumsiness, or lack of coordination
Speech and language problems
Slurred speech or blurred vision
Stiff neck or vomiting
Symptoms improve, and then suddenly get worse (change in consciousness)
CVA; Stroke; etc: Causes
Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage; Ischemic stroke; Stroke - ischemic; Cerebrovascular accident; Stroke - hemorrhagic
A stroke happens when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack."
Causes, incidence, and risk factors
If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.
There are two major types of stroke: ischemic stroke and hemorrhagic stroke.
Arteriovenous malformation (AVM)
Ischemic stroke: Def'n & Causes
Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. This may happen in two ways:
A clot may form in an artery that is already very narrow. This is called a thrombotic stroke.
A clot may break off from another place in the blood vessels of the brain, or from some other part of the body, and travel up to the brain. This is called cerebral embolism, or an embolic stroke.
Ischemic strokes may be caused by clogged arteries. Fat, cholesterol, and other substances collect on the artery walls, forming a sticky substance called plaque.
Hemorrhagic Stroke: Def'n & Causes
A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more likely.
STROKE RISK FACTORS
High blood pressure is the number one risk factor for strokes. The other major risk factors are:
Family history of stroke
Increasing age, especially after age 55
Race (black people are more likely to die of a stroke)
People who have heart disease or poor blood flow in their legs caused by narrowed arteries are also more likely to have a stroke.
The chance of stroke is higher in people who live an unhealthy lifestyle by:
Being overweight or obese
Eating too much fat or salt
Taking cocaine and other illegal drugs
Birth control pills can increase the chances of having blood clots. The risk is highest in woman who smoke and are older than 35.
The symptoms of stroke depend on what part of the brain is damaged. In some cases, a person may not know that he or she has had a stroke.
Symptoms usually develop suddenly and without warning. Or, symptoms may occur on and off for the first day or two. Symptoms are usually most severe when the stroke first happens, but they may slowly get worse.
A headache may occur, especially if the stroke is caused by bleeding in the brain. The headache:
Starts suddenly and may be severe
Occurs when you are lying flat
Wakes you up from sleep
Gets worse when you change positions or when you bend, strain, or cough
Other symptoms depend on how severe the stroke is and what part of the brain is affected. Symptoms may include:
Change in alertness (including sleepiness, unconsciousness, and coma)
Changes in hearing
Changes in taste
Changes that affect touch and the ability to feel pain, pressure, or different temperatures
Confusion or loss of memory
Difficulty writing or reading
Dizziness or abnormal feeling of movement (vertigo)
Lack of control over the bladder or bowels
Loss of balance
Loss of coordination
Muscle weakness in the face, arm, or leg (usually just on one side)
Numbness or tingling on one side of the body
Personality, mood, or emotional changes
Problems with eyesight, including decreased vision, double vision, or total loss of vision
Trouble speaking or understanding others who are speaking
Stroke: Signs & Tests
A complete exam should be done. Your doctor will:
Check for problems with vision, movement, feeling, reflexes, understanding, and speaking. Your doctor and nurses will repeat this exam over time to see if your stroke is getting worse or improving.
Listen for an abnormal sound, called a "bruit," when using a stethoscope to listen to the carotid arteries in the neck. A bruit is caused by abnormal blood flow.
Check your blood pressure, which may be high.
Tests can help your doctor find the type, location, and cause of the stroke and rule out other disorders.
Angiogram of the head can show which blood vessel is blocked or bleeding
Carotid duplex (ultrasound) can show if the carotid arteries in your neck have narrowed
CT scan of the brain is often done soon after symptoms of a stroke begin. An MRI scan of the brain may be done instead or afterwards
Echocardiogram may be done if the stroke could have been caused by a blood clot from the heart
Magnetic resonance angiography (MRA) or CT angiography may be done to check for abnormal blood vessels in the brain
Other tests include:
Lab tests will include:
Blood cholesterol and sugar
Blood clotting tests (prothrombin time or partial thromboplastin time)
Complete blood count (CBC)
Electrocardiogram (ECG) and heart rhythm monitoring -- to show whether an irregular heartbeat (such as atrial fibrillation) caused the stroke
A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Call 911 or your local emergency number or seek urgent medical care at the first signs of a stroke.
It is very important for people who are having stroke symptoms to get to a hospital as quickly as possible. If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot.
Most of the time, patients must reach a hospital within 3 hours after symptoms begin. Some people may be able to receive these drugs for up to 4 - 5 hours after symptoms begin.
Treatment depends on how severe the stroke was and what caused it. Most people who have a stroke need to stay in a hospital.
TREATMENT IN THE HOSPITAL
Clot-busting drugs (thrombolytic therapy) may be used if the stroke is caused by a blood clot. This medicine breaks up blood clots and helps bring back blood flow to the damaged area. However, not everyone can get this type of medicine.
For these drugs to work, a person must be seen and treatment must begin within 3 hours of when the symptoms first started. A CT scan must be done to see whether the stroke is from a clot or from bleeding.
If the stroke is caused by bleeding instead of clotting, clot-busting drugs (thrombolytics) can cause more bleeding.
Other treatments depend on the cause of the stroke:
Blood thinners such as heparin or warfarin (Coumadin) may be used to treat strokes due to blood clots. Aspirin or clopidogrel (Plavix) may also be used.
Other medicine may be needed to control symptoms such as high blood pressure.
In some situations, a special stroke team and skilled radiologists may be able to use angiography to highlight the clogged blood vessel and open it up.
If bleeding occurred, surgery is often needed to remove blood from around the brain and to fix damaged blood vessels.
Surgery on the carotid artery may be needed.
Carotid artery disease
Carotid artery surgery
Nutrients and fluids may be needed, especially if the person has trouble swallowing. These may be given through a vein (intravenously) or a feeding tube in the stomach (gastrostomy tube). Swallowing trouble may be temporary or permanent.
Physical therapy, occupational therapy, speech therapy, and swallowing therapy will all begin in the hospital.
The goal of treatment after a stroke is to help the patient recover as much function as possible and prevent future strokes.
The recovery time and need for long-term treatment is different for each person. Problems moving, thinking, and talking often improve in the weeks to months after a stroke. A number of people who have had a stroke will keep improving in the months or years after the stroke.
Stroke: Prognosis & Complications
The outlook depends on:
The type of stroke
How much brain tissue is damaged
What body functions have been affected
How quickly you get treated
You may recover completely, or have some permanent loss of function.
Over half of people who have a stroke are able to function and live at home. Other people are not able to care for themselves.
If treatment with clot-busting drugs is successful, the symptoms of a stroke may go away. However, patients often do not get to the hospital soon enough to receive these drugs, or they cannot take these drugs because of a health condition.
People who have a stroke due to a blood clot (ischemic stroke) have a better chance of surviving than those who have a stroke due to bleeding in the brain (hemorrhagic stroke).
The risk for a second stroke is highest during the weeks or months after the first stroke. Then the risk begins to decrease.
Breathing food into the airway (aspiration)
Loss of mobility
Loss of movement or feeling in one or more parts of the body
Problems speaking and understanding
Problems thinking or focusing
Seizure: Def'n & Convulsions
Secondary seizures; Reactive seizures; Seizure - secondary; Seizure - reactive; Convulsions
A seizure is the physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain.
The term "seizure" is often used interchangeably with "convulsion." Convulsions are when a person's body shakes rapidly and uncontrollably. During convulsions, the person's muscles contract and relax repeatedly. There are many different types of seizures. Some have mild symptoms and no body shaking.
Generalized tonic clonic seizure
Partial (focal) seizure
Petit mal (absence) seizure
Fever (febrile) convulsions (seizures in children with high fever)
It may be hard to tell if someone is having a seizure. Some seizures only cause a person to have staring spells. These may go unnoticed.
Specific symptoms depend on what part of the brain is involved. They occur suddenly and may include:
Brief blackout followed by period of confusion (the person cannot remember a period of time)
Changes in behavior such as picking at one's clothing
Drooling or frothing at the mouth
Grunting and snorting
Loss of bladder or bowel control
Mood changes such as sudden anger, unexplainable fear, panic, joy, or laughter
Shaking of the entire body
Tasting a bitter or metallic flavor
Temporary halt in breathing
Uncontrollable muscle spasms with twitching and jerking limbs
Symptoms may stop after a few seconds minutes, or continue for 15 minutes. They rarely continue longer.
The person may have warning symptoms before the attack, such as:
Fear or anxiety
Visual symptoms (such as flashing bright lights, spots, or wavy lines before the eyes)
Seizure: Common Causes
Seizures of all types are caused by disorganized and sudden electrical activity in the brain.
Causes of seizures can include:
Abnormal levels of sodium or glucose in the blood
Brain infection, including meningitis
Brain injury that occurs to the baby during labor or childbirth
Brain problems that occur before birth (congenital brain defects)
Brain tumor (rare)
Fever (particularly in young children)
Heat illness (see heat intolerance)
Illicit drugs, such as angel dust (PCP), cocaine, amphetamines
Kidney or liver failure
Low blood sugar
Phenylketonuria (PKU), which can cause seizures in infants
Toxemia of pregnancy
Uremia related to kidney failure
Very high blood pressure (malignant hypertension)
Venomous bites and stings (see snake bite)
Use of illegal street drugs, such as cocaine or amphetamines
Withdrawal from alcohol after drinking a lot on most days
Withdrawal from certain drugs, including some painkillers and sleeping pills
Withdrawal from benzodiazepines (such as Valium)
Sometimes no cause can be identified. This is called idiopathic seizures. They usually are seen in children and young adults but can occur at any age. There may be a family history of epilepsy or seizures.
If seizures repeatedly continue after the underlying problem is treated, the condition is called epilepsy.
Temporal lobe epilepsy; Seizure disorder
Epilepsy is a brain disorder in which a person has repeated seizures (convulsions) over time. Seizures are episodes of disturbed brain activity that cause changes in attention or behavior.
See also: Seizures
Causes, incidence, and risk factors
Epilepsy occurs when permanent changes in brain tissue cause the brain to be too excitable or jumpy. The brain sends out abnormal signals. This results in repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.)
Epilepsy may be due to a medical condition or injury that affects the brain, or the cause may be unknown (idiopathic).
Common causes of epilepsy include:
Stroke or transient ischemic attack (TIA)
Dementia, such as Alzheimer's disease
Traumatic brain injury
Infections, including brain abscess, meningitis, encephalitis, and AIDS
Brain problems that are present at birth (congenital brain defect)
Brain injury that occurs during or near bith
Metabolism disorders that a child may be born with (such as phenylketonuria)
Abnormal blood vessels in the brain
Other illness that damage or destroy brain tissue
Epilepsy seizures usually begin between ages 5 and 20, but they can happen at any age. There may be a family history of seizures or epilepsy.
Symptoms vary from person to person. Some people may have simple staring spells, while others have violent shaking and loss of alertness. The type of seizure depends on the part of the brain affected and cause of epilepsy.
Most of the time, the seizure is similar to the previous one. Some people with epilepsy have a strange sensation (such as tingling, smelling an odor that isn't actually there, or emotional changes) before each seizure. This is called an aura.
For a detailed description of the symptoms associated with a specific type of seizure, see:
Absence (petit mal) seizure
Generalized tonic-clonic (grand mal) seizure
Partial (focal) seizure
Epilepsy: Signs & Tests
The doctor will perform a physical exam, which will include a detailed look at the brain and nervous system.
An EEG (electroencephalogram) will be done to check the electrical activity in the brain. People with epilepsy will often have abnormal electrical activity seen on this test. In some cases, the test may show the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures.
To diagnose epilepsy or plan for epilepsy surgery:
You may need to wear an EEG recorder for days or weeks while you go about your everyday life.
You may need to stay in a special hospital where brain activity can be be watched on video cameras. This is called video EEG.
Tests that may be done include:
CBC (complete blood count)
Kidney function tests
Liver function tests
Lumbar puncture (spinal tap)
Tests for infectious diseases
Head CT or MRI scan often done to find the cause and location of the problem in the brain.
Treatment for epilepsy may involve surgery or medication.
If epilepsy seizures are due to a tumor, abnormal blood vessels, or bleeding in the brain, surgery to treat these disorders may make the seizures stop.
Medication to prevent seizures, called anticonvulsants, may reduce the number of future seizures.
These drugs are taken by mouth. Which type you are prescribed depends on the type of seizures you have.
Your dosage may need to be changed from time to time. You may need regular blood tests to check for side effects.
Always take your medication on time and as directed. Missing a dose can cause you to have a seizure. Never not stop taking or change medications without talking to your doctor first.
Many epilepsy medications cause birth defects. Women wishing to become pregnant should tell the doctor in advance in order to adjust medications.
Epilepsy that does not get better after two or three anti-seizure drugs have been tried is called "medically refractory epilepsy."
Surgery to remove the abnormal brain cells causing the seizures may be helpful for some patients.
Surgery to place a vagus nerve stimulator (VNS) may be recommended. This device is similiar to a heart pacemaker. It can help reduce the number of seizures.
Sometimes, children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, may also be helpful in some adults.
Lifestyle or medical changes can increase the risk for a seizure in a person with epilepsy. Talk with your doctor about:
New prescribed medications, vitamins, or supplements
Illness, especially infection
Lack of sleep
Skipping doses of epilepsy medications
Use of alcohol or other recreational drugs
Persons with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs.
Persons with poorly controlled epilepsy should not drive. Each state has a different law about which people with a history of seizures are allowed to drive.
Also avoid machinery or activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone.
See also: Seizures - first aid.
Epilepsy: Prognosis & Complications
Some people with epilepsy may be able to reduce or even stop their anti-seizure medicines after having no seizures for several years. Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s.
For many people, epilepsy is a lifelong condition. In these cases, the anti-seizure drugs need to be continued. There is a very low risk of sudden death with epilepsy. However, serious injury can occur if a seizure occurs during driving or when operating equipment.
Breathing in food or saliva into the lungs during a seizure, which can cause aspiration pneumonia
Injury from falls, bumps, self-inflicted bites, driving or operating machinery during a seizure
Permanent brain damage (stroke or other damage)
Side effects of medications
Senile dementia - Alzheimer's type (SDAT); SDAT
Last reviewed: September 26, 2011.
Dementia is a loss of brain function that occurs with certain diseases. Alzheimer's disease (AD), is one form of dementia that gradually gets worse over time. It affects memory, thinking, and behavior.
Alzheimer's: Causes, Incidence, Risk Factors
Causes, incidence, and risk factors
You are more likely to get Alzheimer's disease (AD) if you:
Are older. However, developing AD is not a part of normal aging.
Have a close blood relative, such as a brother, sister, or parent with AD.
Have certain genes linked to AD, such as APOE epsilon4 allele
The following may also increase your risk, although this is not well proven:
Having high blood pressure for a long time
History of head trauma
There are two types of AD:
Early onset AD: Symptoms appear before age 60. This type is much less common than late onset. However, it tends to get worse quickly. Early onset disease can run in families. Several genes have been identified.
Late onset AD: This is the most common type. It occurs in people age 60 and older. It may run in some families, but the role of genes is less clear.
The cause of AD is not clear. Your genes and environmental factors seem to play a role. Aluminum, lead, and mercury in the brain is no longer believed to be a cause of AD.
Dementia symptoms include difficulty with many areas of mental function, including:
Emotional behavior or personality
Thinking and judgement (cognitive skills)
Dementia usually first appears as forgetfulness.
Mild cognitive impairment is the stage between normal forgetfulness due to aging, and the development of AD. People with MCI have mild problems with thinking and memory that do not interfere with everyday activities. They are often aware of the forgetfulness. Not everyone with MCI develops AD.
Symptoms of MCI include:
Difficulty performing more than one task at a time
Difficulty solving problems
Forgetting recent events or conversations
Taking longer to perform more difficult activities
The early symptoms of AD can include:
Difficulty performing tasks that take some thought, but used to come easily, such as balancing a checkbook, playing complex games (such as bridge), and learning new information or routines
Getting lost on familiar routes
Language problems, such as trouble finding the name of familiar objects
Losing interest in things previously enjoyed, flat mood
Personality changes and loss of social skills
As the AD becomes worse, symptoms are more obvious and interfere with your ability to take care of yourself. Symptoms can include:
Change in sleep patterns, often waking up at night
Delusions, depression, agitation
Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, and driving
Difficulty reading or writing
Forgetting details about current events
Forgetting events in your own life history, losing awareness of who you are
Hallucinations, arguments, striking out, and violent behavior
Poor judgment and loss of ability to recognize danger
Using the wrong word, mispronouncing words, speaking in confusing sentences
Withdrawing from social contact
People with severe AD can no longer:
Recognize family members
Perform basic activities of daily living, such as eating, dressing, and bathing
Other symptoms that may occur with AD:
Alzheimer's: Signs & Tests
A skilled health care provider can often diagnose AD disease with the following steps:
Complete physical exam, including neurological exam
Asking questions about your medical history and symptoms
A mental status examination
A diagnosis of AD is made when certain symptoms are present, and by making sure other causes of dementia are not present.
Tests may be done to rule out other possible causes of dementia, including:
Intoxication from medication
Computed tomography (CT) or magnetic resonance imaging (MRI) of the brain may be done to look for other causes of dementia, such as a brain tumor or stroke.
In the early stages of dementia, brain image scans may be normal. In later stages, an MRI may show a decrease in the size of different areas of the brain.
While the scans do not confirm the diagnosis of AD, they do exclude other causes of dementia (such as stroke and tumor).
However, the only way to know for certain that someone has AD is to examine a sample of their brain tissue after death. The following changes are more common in the brain tissue of people with AD:
"Neurofibrillary tangles" (twisted fragments of protein within nerve cells that clog up the cell)
"Neuritic plaques" (abnormal clusters of dead and dying nerve cells, other brain cells, and protein)
"Senile plaques" (areas where products of dying nerve cells have accumulated around protein).
There is no cure for AD. The goals of treatment are:
Slow the progression of the disease (although this is difficult to do)
Manage symptoms, such as behavior problems, confusion, and sleep problems
Change your home environment so you can better perform daily activities
Support family members and other caregivers
Medicines are used to help slow down the rate at which symptoms become worse. The benefit from these drugs is usually small. You and your family may not notice much of a change.
Before using these medicines, ask the doctor or nurse:
What are the potential side effects? Is the medicine worth the risk?
When is the best time, if any, to use these medicines?
Medicines for AD include:
Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne, formerly called Reminyl). Side effects include stomach upset, diarrhea, vomiting, muscle cramps, and fatigue.
Memantine (Namenda). Possible side effects include agitation or anxiety.
Other medicines may be needed to control aggressive, agitated, or dangerous behaviors. Examples include haloperidol, risperidone, and quetiapine. These are usually given in very low doses due to the risk of side effects including an increased risk of death.
It may be necessary to stop any medications that make confusion worse. Such medicines may include painkillers, cimetidine, central nervous system depressants, antihistamines, sleeping pills, and others. Never change or stop taking any medicines without first talking to your doctor.
Some people believe certain vitamins and herbs may help prevent or slowdown AD.
There is no strong evidence that Folate (vitamin B6), vitamin B12, and vitamin E prevent AD or slows the disease once it occurs.
High-quality studies have not shown that ginkgo biloba lowers the chance of developing dementia. DO NOT use ginkgo if you take blood-thinning medications like warfarin (Coumadin) or a class of antidepressants called monoamine oxidase inhibitors (MAOIs).
If you are considering any drugs or supplements, you should talk to your doctor first. Remember that herbs and supplements available over the counter are NOT regulated by the FDA.
Alzheimer's: Expectations & Complications
How quickly AD gets worse is different for each person. If AD develops quickly, it is more likely to worsen quickly.
Patients with AD often die earlier than normal, although a patient may live anywhere from 3 - 20 years after diagnosis.
The final phase of the disease may last from a few months to several years. During that time, the patient becomes totally disabled. Death usually occurs from an infection or organ failure.
Abuse by an over-stressed caregiver
Loss of muscle function that makes you unable to move your joints
Infection, such as urinary tract infection and pneumonia
Other complications related to immobility
Falls and broken bones
Harmful or violent behavior toward self or others
Loss of ability to function or care for self
Loss of ability to interact
Malnutrition and dehydration
Parkinson's Disease: Def'n
Paralysis agitans; Shaking palsy
Parkinson's disease is a disorder of the brain that leads to shaking (tremors) and difficulty with walking, movement, and coordination
Parkinson's Disease: Causes, incidence, and risk factors
Parkinson's disease most often develops after age 50. It is one of the most common nervous system disorders of the elderly. Sometimes Parkinson's disease occurs in younger adults. It affects both men and women.
In some cases, Parkinson's disease runs in families. When a young person is affected, it is usually because of a form of the disease that runs in families.
Nerve cells use a brain chemical called dopamine to help control muscle movement. Parkinson's disease occurs when the nerve cells in the brain that make dopamine are slowly destroyed. Without dopamine, the nerve cells in that part of the brain cannot properly send messages. This leads to the loss of muscle function. The damage gets worse with time. Exactly why these brain cells waste away is unknown.
Parkinson's is rare in children. It may occur because the nerves are not as sensitive to dopamine.
The term "parkinsonism" refers to any condition that involves the types of movement changes seen in Parkinson's disease. Parkinsonism may be caused by other disorders (called secondary parkinsonism) or certain medications.
Parkinson's Disease: Sx
Symptoms may be mild at first. For instance, you may have a mild tremor or a slight feeling that one leg or foot is stiff and dragging. Symptoms may affect one or both sides of the body, and can include:
Problems with balance and walking
No expression in the face (like you are wearing a mask)
Muscle aches and pains
Movement problems, which include:
Difficulty starting movement, such as starting to walk or getting out of a chair
Difficulty continuing to move
Loss of small or fine hand movements; writing may become small and difficult to read; eating becomes difficults
Rigid or stiff muscles, often beginning in the legs
Shaking, called tremors
Usually occurs in the limbs at rest, or when the arm or leg is held out
Goes away when you move
Eventually may be seen in the head, lips, tongue, and feet
May be worse when tired, excited, or stressed
Finger-thumb rubbing (pill-rolling tremor) may be present
Slowed, quieter speech and monotone voice
Low blood pressure when getting up, sweating, drooling, lack of body temperature control. These problems are due to something called autonomic dysfunction.
Other symptoms may include:
Anxiety, stress, and tension
Parkinson's Disease: Signs & Tests
Your health care provider may be able to diagnose Parkinson's disease based on your symptoms and a physical examination. However, the symptoms can be difficult to assess, particularly in the elderly. They become more clear as the illness gets worse.
A doctor's examination may show:
Difficulty starting or finishing voluntary movements
Jerky, stiff movements
Changes in your heart rate
Reflexes should be normal.
Tests may be needed to rule out other disorders that cause similar symptoms.
Parkinson's Disease: Tx
There is no known cure for Parkinson's disease. The goal of treatment is to control symptoms.
Medications control symptoms, mostly by increasing the levels of dopamine in the brain. At certain points during the day, the helpful effects of the medication often wears off, and symptoms can return. If this happens to you, your health care provider may need to change the:
Type of medication
Amount of time between doses
How the medicine is taken
Work closely with your doctors and therapists to find a treatment program that works best for you. Never change or stop taking any medications without talking with your doctor.
Many medications can cause severe side effects, including hallucinations, nausea, vomiting, diarrhea, and delirium. Monitoring and follow-up by the health care provider is important.
Eventually, symptoms such as stooped posture, frozen movements, and speech difficulties may not respond very well to drug treatment.
Medications used to treat movement-related symptoms of Parkinson's disease include:
Levodopa (L-dopa), Sinemet, levodopa and carbidopa (Atamet)
Pramipexole (Mirapex), ropinirole (Requip), bromocriptine (Parlodel)
Selegiline (Eldepryl, Deprenyl), rasagiline (Azilect)
Amantadine or anticholinergic medications to reduce early or mild tremors
Other medications may include:
Memantine, rivastigmine, galantamine for cognitive difficulties
Antidepressants for mood disorders
Gabapentin, duloxetine for pain
Fludrocortisone, midodrine, botox, sidenafil for autonomic dysfunction
Armodafinil, clonazepam, zolpidem for sleep disorders
Lifestyle changes may be helpful for Parkinson's disease:
Good general nutrition and health. Changes in what you eat or drink are needed if there are swallowing problems
Exercising, but adjusting the activity level to meet changing energy levels
Regular rest periods and avoiding stress
Physical therapy, speech therapy, and occupational therapy
Railings or banisters placed in commonly used areas of the house. Other changes may be needed around the home to prevent falls and make the bathroom safe.
Assistive devices, such as special eating utensils, wheelchairs, bed lifts, shower chairs, walkers, and wall bars
Social workers or other counseling services to help you cope with the disorder and get assistance (such as Meals-on-Wheels)
Surgery may be an option for some patients with Parkinson's disease. These surgeries do not cure Parkinson's, but may help ease symptoms.
Deep brain stimulation involves placing electrical stimulators in specific areas of the brain that control movement.
Another type of surgery destroys brain issues that cause Parkinson's symptoms.
Stem cell transplant and other clinical trials are currently ongoing in the USA. For information, see: www.pdtrials.org
Parkinson's Disease: Expectations & Complications
Untreated, the disorder will get worse until a person is totally disabled. Parkinson's may lead to a deterioration of all brain functions, and an early death.
Most people respond to medications. How much the medications relieve symptoms, and for how long can be very different in each person. The side effects of medications may be severe.
Difficulty performing daily activities
Difficulty swallowing or eating
Disability (differs from person to person)
Injuries from falls
Pneumonia from breathing in (aspirating) saliva
Side effects of medications
Multiple Sclerosis: Def'n
MS; Demyelinating disease
Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord (central nervous system).
Multiple Sclerosis: Causes, Incidence & Risk Factors
Multiple sclerosis (MS) affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40, but can be seen at any age.
MS is caused by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow down or stop.
The nerve damage is caused by inflammation. Inflammation occurs when the body's own immune cells attack the nervous system. This can occur along any area of the brain, optic nerve, and spinal cord.
It is unknown what exactly causes this to happen. The most common thought is that a virus or gene defect, or both, are to blame. Environmental factors may play a role.
You are slightly more likely to get this condition if you have a family history of MS or live in an part of the world where MS is more common.
Multiple Sclerosis: Sx
Symptoms vary, because the location and severity of each attack can be different. Episodes can last for days, weeks, or months. These episodes alternate with periods of reduced or no symptoms (remissions).
Fever, hot baths, sun exposure, and stress can trigger or worsen attacks.
It is common for the disease to return (relapse). However, the disease may continue to get worse without periods of remission.
Because nerves in any part of the brain or spinal cord may be damaged, patients with multiple sclerosis can have symptoms in many parts of the body.
Loss of balance
Numbness or abnormal sensation in any area
Problems moving arms or legs
Problems with coordination and making small movements
Tremor in one or more arms or legs
Weakness in one or more arms or legs
Bowel and bladder symptoms:
Constipation and stool leakage
Difficulty beginning to urinate
Frequent need to urinate
Strong urge to urinate
Urine leakage (incontinence)
Uncontrollable rapid eye movements
Vision loss (usually affects one eye at a time)
Numbness, tingling, or pain
Painful muscle spasms
Tingling, crawling, or burning feeling in the arms and legs
Other brain and nerve symptoms:
Decreased attention span, poor judgment, and memory loss
Difficulty reasoning and solving problems
Depression or feelings of sadness
Dizziness and balance problems
Problems with erections
Problems with vaginal lubrication
Speech and swallowing symptoms:
Slurred or difficult-to-understand speech
Trouble chewing and swallowing
Fatigue is a common and bothersome symptoms as MS progresses. It is often worse in the late afternoon.
Multiple Sclerosis: Signs & Tests
Symptoms of MS may mimic those of many other nervous system disorders. The disease is diagnosed by ruling out other conditions.
People who have a form of MS called relapsing-remitting may have a history of at least two attacks, separated by a period of reduced or no symptoms.
The health care provider may suspect MS if there are decreases in the function of two different parts of the central nervous system (such as abnormal reflexes) at two different times.
A neurological exam may show reduced nerve function in one area of the body, or spread over many parts of the body. This may include:
Abnormal nerve reflexes
Decreased ability to move a part of the body
Decreased or abnormal sensation
Other loss of nervous system functions
An eye examination may show:
Abnormal pupil responses
Changes in the visual fields or eye movements
Decreased visual acuity
Problems with the inside parts of the eye
Rapid eye movements triggered when the eye moves
Tests to diagnose multiple sclerosis include:
Lumbar puncture (spinal tap) for cerebrospinal fluid tests, including CSF oligoclonal banding
MRI scan of the brain and MRI scan of the spine are important to help diagnose and follow MS
Nerve function study (evoked potential test)
Multiple Sclerosis: Tx
There is no known cure for multiple sclerosis at this time. However, there are therapies that may slow the disease. The goal of treatment is to control symptoms and help you maintain a normal quality of life.
Medications used to slow the progression of multiple sclerosis are taken on a long-term basis, they include:
Interferons (Avonex, Betaseron, or Rebif), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), and natalizumab (Tysabri)
Fingolimod (Gilenya )
Methotrexate, azathioprine (Imuran), intravenous immunoglobulin (IVIg) and cyclophosphamide (Cytoxan) may also be used if the above drugs are not working well
Steroids may be used to decrease the severity of attacks.
Medications to control symptoms may include:
Medicines to reduce muscle spasms such as Lioresal (Baclofen), tizanidine (Zanaflex), or a benzodiazepine
Cholinergic medications to reduce urinary problems
Antidepressants for mood or behavior symptoms
Amantadine for fatigue
For more information see:
The following may also be helpful for people with MS:
Physical therapy, speech therapy, occupational therapy, and support groups
Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars
A planned exercise program early in the course of the disorder
A healthy lifestyle, with good nutrition and enough rest and relaxation
Avoiding fatigue, stress, temperature extremes, and illness
Changes in what you eat or drink if there are swallowing problems
Making changes around the home to prevent falls
Social workers or other counseling services to help you cope with the disorder and get assistance (such as Meals-on-Wheels)
For more information about living with MS, see: Multiple sclerosis - at home
Household changes to ensure safety and ease in moving around the home are often needed.
Multiple Sclerosis: Prognosis & Complications
The outcome varies, and is hard to predict. Although the disorder is chronic and incurable, life expectancy can be normal or almost normal. Most people with MS continue to walk and function at work with minimal disability for 20 or more years.
The following typically have the best outlook:
People who were young (less than 30 years) when the disease started
People with infrequent attacks
People with a relapsing-remitting pattern
People who have limited disease on imaging studies
The amount of disability and discomfort depends on:
How often you have attacks
How severe they are
The part of the central nervous system that is affected by each attack
Most people return to normal or near-normal function between attacks. Slowly, there is greater loss of function with less improvement between attacks. Over time, many require a wheelchair to get around and have a more difficult time transferring out of the wheelchair.
Those with a support system are often able to remain in their home.
Less and less ability to care for self
Need for indwelling catheter
Osteoporosis or thinning of the bones
Side effects of medications used to treat the disorder
Urinary tract infections